DAVID L. OSHIN, M.D.
To the editor: Noncardiac chest pain is indeed "a vexing diagnostic problem," as Richter and colleagues (1) note at the outset of their recent article on edrophonium provocation of esophageal chest pain. However, their conclusions regarding the superiority of edrophonium to ergonovine as a diagnostic agent in this setting are open to question.
Ideally, any patient with chest pain suggestive of coronary artery disease significant enough to warrant coronary angiography should be administered ergonovine during angiography if no hemodynamically significant coronary obstructions or other findings sufficient to explain the symptoms are noted. Only if focal coronary artery spasm is excluded
OSHIN DL. Edrophonium, Ergonovine, and the Diagnosis of Chest Pain. Ann Intern Med. ;103:958–959. doi: 10.7326/0003-4819-103-6-958_2
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Published: Ann Intern Med. 1985;103(6_Part_1):958-959.
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